Written Answers Nos. 379-398
379. Deputy Denis Naughten asked the Minister for Health further to Parliamentary Question No. 523 of 20 February 2024, his plans for the future location of the main laboratory for genetic testing in Ireland, which is currently housed at CHI Crumlin; the reason this is not being accommodated in the new children's hospital; and if he will make a statement on the matter. [26794/24]
View answerThe Government and I are fully committed to developing a robust patient and family centred genetics and genomics service in Ireland and increasing genomic laboratory capabilities for the betterment of patient diagnostics and care.
In 2016, the National Genetic and Genomic Medicine Network strategy group provided a report to the HSE. This report outlined the future of genetic and genomic services in Ireland. It recommended that a national approach to clinical and laboratory genetics and genomics should be developed. It also highlighted that the existing laboratory in CHI Crumlin was not designed to deliver a national function in this regard.
Following on from this report, the National Strategy for Accelerating Genetic and Genomic in Ireland was launched in 2022. In line with Sláintecare, the strategy outlines a clear approach to developing sustainable patient and family centred genetics and genomics service.
An important element of achieving this is increasing genomic laboratory capabilities in Ireland. Strengthening infrastructure to drive advances in genetics and genomics is a key objective of the strategy’s focus. This will lead to the development of a centralised national centre for genomic medicine services including genomic testing and bioinformatics.
The development of this national centre will increase genomic testing capacities in Ireland, ultimately reducing waiting times and improving patient outcomes in areas such as rare diseases and cancer.
As the current focus of work is on assessment of existing capacity and need, a decision on the location of this new national centre has not yet been made. In the meantime, and while the 2022 Strategy is being implemented, genetic and genomic testing will continue to be carried out in existing sites as appropriate.
In addition to a centralised, national approach to genomic testing, a number of important projects are underway to improve genetics services in Ireland. This year, the HSE National Genetics and Genomics Office (NGGO) will focus on the identification of current test providers (both national and international) used to meet the genetic and genomic testing needs of Irish patients. The information gathered through this process and a clinical operating model (which is currently being developed) will enable the future development of genetic and genomic laboratory capacity.
Another priority deliverable for 2024 is the development of a National Genomic Test Directory for Rare and Inherited Diseases. The NGGO have engaged with potential service users to understand the clinical need, to ensure this test directory appropriately meets that need. This directory will be a key enabling document used to inform the development of new genomic laboratory capacity.
Beyond 2024, the Government and I remain committed to continue planning for the development of the national centre for genomics services, including consideration of appropriate locations to host this centre.
380. Deputy Cormac Devlin asked the Minister for Health the number of full-time equivalent paramedics employed by the National Ambulance Service in each of the years 2019 to 2023, in tabular form; the number of full-time equivalent paramedics recruited by the service over the corresponding period; the number of successful candidates on recruitment panels on 1 June 2024; and if he will make a statement on the matter. [26804/24]
View answerAs this is a service matter, I have asked the Health Service Executive (HSE) to respond to the Deputy directly, as soon as possible.
381. Deputy Niamh Smyth asked the Minister for Health to provide an update on the home care package application for triplets (details supplied); and if he will make a statement on the matter. [26807/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
382. Deputy Niamh Smyth asked the Minister for Health to review a case (details supplied); if he can provide any advice or support on this matter; and if he will make a statement on the matter. [26808/24]
View answerGPs are private practitioners, most of whom hold a GMS contract with the HSE for the provision of GP services without charge to medical card and GP visit card holders. As self-employed practitioners, GPs may establish practices at a place of their own choosing. There is no prescribed ratio of GPs to patients and the State does not regulate the number of GPs that can set up in a town or community.
As GPs are private practitioners, the scheduling of consultations is a matter for each individual practice. Where scheduling is required, GPs prioritise appointments based on urgency and health need.
The Government is working to increase the number of GPs practicing in the State and thereby improve access to GP services across the country.
Under the 2019 GP Agreement additional annual expenditure provided for general practice was increased by €211.6m. This provided for significant increases in capitation fees for participating GMS GPs, and new fees for additional services and increased practice supports. The GP Agreement 2023 further increased GP capitation fees, increased the existing subsidy rates for practice staff, and introduced a grant support for additional staff capacity as well a practice staff maternity leave support. These measures make general practice in Ireland a more attractive career choice for doctors.
The number of doctors entering GP training has been increased significantly in recent years, with 286 new entrants in 2023 and 350 places made available for new entrants for this year. Annual intake to the GP training scheme has been increased by over 80% from 2015 to 2023, and the number of new entrant places to be available this year is a 22% increase on last year's intake.
Furthermore, GP recruitment is ongoing under the joint International Medical Graduate Rural GP Programme between the HSE and the Irish College of General Practitioners (ICGP). 121 non-EU GPs were enrolled under the training programme last year and it is planned to recruit up to 250 more GPs from outside Ireland this year. The placement of GPs under the programme is targeted to rural and underserviced areas.
Lastly, a Strategic Review of General Practice is underway. The review, with input from key stakeholders, is examining the broad range of issues affecting general practice including issues related to GP capacity. When completed, the review will set out the measures necessary to deliver a more sustainable general practice into the future.
383. Deputy Peadar Tóibín asked the Minister for Health if his Department will consider part-funding the running of Daisy Hill Hospital to allow it serve the populations of east Monaghan and north Louth. [26811/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
384. Deputy Michael Healy-Rae asked the Minister for Health when test results will be made available to a person (details supplied); and if he will make a statement on the matter. [26825/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
385. Deputy Steven Matthews asked the Minister for Health the position regarding the building previously used as the Donard health centre, County Wicklow; if his Department proposes to bring the centre back into use; and if he will make a statement on the matter. [26832/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
386. Deputy Thomas Gould asked the Minister for Health the staffing levels in CAMHS in Cork in each month of 2024, in tabular form. [26833/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond direct to the Deputy.
387. Deputy Neasa Hourigan asked the Minister for Health for an update on the rollout of spinal muscular atrophy testing under the National Newborn Bloodspot Screening Programme; when he expects the first baby to be tested; and if he will make a statement on the matter. [26835/24]
View answer470. Deputy Ged Nash asked the Minister for Health for an update on the rollout of spinal muscular atrophy in the National Newborn Bloodspot Screening Programme; when he expects the first baby to be tested in Ireland for this potentially devastating disease; and if he will make a statement on the matter. [27121/24]
View answer471. Deputy Ged Nash asked the Minister for Health the preparations that his Department and the HSE are making to ensure that every baby in Ireland is tested for spinal muscular atrophy in the National Newborn Bloodspot Screening Programme as per his announcement in November 2023; when he expects the testing to be implemented; and if he will make a statement on the matter. [27122/24]
View answer472. Deputy Ged Nash asked the Minister for Health how the additional €700,000 funding he secured in Budget 2024 to expand the National Newborn Bloodspot Screening Programme will be spent; if he can give assurances that the funding is sufficient to ensure spinal muscular atrophy is included in the heel prick test in 2024 as per his commitment; and if he will make a statement on the matter. [27123/24]
View answerI propose to take Questions Nos. 387 and 470 to 472, inclusive, together.
The expansion of the National Newborn Bloodspot Screening (NBS) Programme continues to remain a key objective of mine as Minister for Health, and I am pleased to note that the National Screening Advisory Committee (NSAC) has been actively progressing work in this regard.
NSAC is an independent expert group that considers and assesses evidence in a robust and transparent manner, and against internationally accepted criteria. It is important that we have rigorous processes in place to ensure our screening programmes are effective, quality assured, validated and operating to safe standards, and that the benefits of screening outweigh the harms.
Significant progress continues to be made on the expansion of the NBS Programme. As the Deputy will be aware, last year I approved two recommendations from NSAC for the addition of Severe Combined Immunodeficiency (SCID) and Spinal Muscular Atrophy (SMA) to the NBS programme. This will bring the number of conditions screened for as part of what is commonly known as the ‘heel prick’ test in Ireland to 11, once implemented. I would highlight that this will represent a 37% increase achieved under the lifetime of this Government.
I can confirm that work commenced at the start of this year, with ongoing collaboration between officials in my Department and the HSE National Children’s Screening Programme on implementing an ambitious timeline for the introduction of screening for SMA and SCID.
In February of this year, I was pleased to allocate €1.4m of new development funding in 2024 to support the expansion of the NBS programme. This funding will allow for the rollout of testing for both SCID and SMA and represents a significant funding increase in a single year. The announcement further demonstrates my ongoing commitment to reducing the impact of these rare but serious diseases in children and infants. This investment will be crucial to providing additional funds for new equipment, staff recruitment, validation, quality assurance and training to facilitate addition of new conditions to NBS programme.
The introduction of screening for SMA will enable earlier identification and diagnosis, thereby facilitating earlier disease management and treatment. I am acutely aware of how difficult it is for parents, families and children who have received a diagnosis of a rare disease, and how challenging daily life can be for them. Screening will make a real difference to their lives, which is why I am determined to see testing introduced for SMA as soon as possible.
388. Deputy Brian Stanley asked the Minister for Health if minutes are taken at the multidisciplinary meetings at St. James Hospital; if those minutes are published; and is there a record of attendees. [26844/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
389. Deputy Róisín Shortall asked the Minister for Health the status of the public health obesity Bill committed to in the Programme for Government; the timeline for publication of the draft heads; and if he will make a statement on the matter. [26848/24]
View answerThe Programme for Government “Our Shared Future” published in June 2020 contained a commitment to “Work with key stakeholders to introduce a Public Health Obesity Act, including examining restrictions on promotion and advertising aimed at children”. The policy instrument for obesity in Ireland is 'A Healthy Weight for Ireland,’ the Obesity Policy and Action Plan (OPAP), which was launched in September 2016 as part of the Healthy Ireland Framework.
The OPAP covers a 10-year period up to 2025 and aims to reverse obesity trends, prevent health complications, and reduce the overall burden for individuals, families, the health system, and the wider society and economy.? The OPAP includes a suite of prevention measures which were identified by the World Health Organisation (WHO, 2008) as cost-effective interventions, ranging from education and schools-based programmes to reformulation and fiscal policies with the aim of gradually changing Ireland’s obesogenic environment to facilitate consumption of healthier foods and drinks. A mid-term evaluation was conducted by UCC which covered the period 2016 to May 2021 which examined implementation and progress on delivery of the actions under the OPAP.
Separately, in 2022, the Department of Health conducted a Review of the OPAP which provided an update on the status of some of the main deliverables in the Ten Steps suite of population-health approaches of the OPAP. It also aligns the Ten Steps suite of population-health approaches in OPAP with the WHO European Regional Obesity Report 2022 and the policy options the WHO recommends on managing obesity throughout the life course, thus signposting key actions to consider out to 2025. The Review was published in November 2022 and can be found on the Healthy Ireland website at gov.ie - Healthy Ireland Policies (www.gov.ie).
There is currently no timeline for the development of a Public Health Obesity Bill. However, in relation to specific legislation relating to promotion and advertising aimed at children in the context of addressing obesity, my colleague, the Minister for Tourism, Culture, Arts, Gaelteacht, Sport and Media ("TCAGSM"), brought the Online Safety and Media Regulation Bill through the Houses of the Oireachtas and it was signed into law on 10 December 2022. Following its commencement by the Minister, the Online Safety and Media Regulation (OSMR) Act 2022 dissolved the Broadcasting Authority of Ireland (BAI).
Coimisiún na Meán was established in March 2023, further to the provisions of the Online Safety and Media Regulation Act 2022 (“OSMR Act 2022”). The OSMR Act 2022 amended the Broadcasting Act 2009 to establish Coimisiún na Meán and dissolve the Broadcasting Authority of Ireland (“BAI”). In addition to undertaking the functions of the BAI as the regulator for broadcasting in Ireland, Coimisiún na Meán is to establish a regulatory framework for online safety, update the regulation of television broadcasting and audiovisual on-demand services, and transpose the revised Audiovisual Media Services Directive into Irish law.
Officials from the Department of Health have met with officials from An Coimisiún to discuss implementing codes that would restrict the marketing of high fat, sugar and salt foods and beverages to children, including follow on infant formula and will continue to engage with An Coimisiún going forward.
A significant amount of work has already been progressed at an EU level with regard to the marketing of unhealthy foods to children. Ireland and Portugal have co-led a Work Package on Restricting the marketing of unhealthy foods to children and adolescents under the EU Joint Action “Best ReMaP” (Best practices in Reformulation, Marketing and public Procurement), working with 15 other Member States which completed its work in September 2023.
This includes proposing a revised WHO Nutrient Profiling Model for use throughout Europe in implementing the Audio-Visual Media Services Directive. This model will also be used in the EU Codes of Practice templates, adaptable by Member States, for use with non-broadcast media, including digital media; product placement (including multi-buy options) and sponsorship. As part of this Work Package, a Digital Media Monitoring Framework is being developed for EU-wide use.
The EU Framework for Action is the final deliverable of the Joint Action Best-ReMaP Work Package 6, which was finalized by September 2023. This framework contains all the tools developed by the Work Package. Member States have also recently established National Intersectoral Working Groups, to facilitate the implementation of the food marketing tools developed by the Joint Action Best-ReMaP and the integration of policies into national legislation after the end of the Joint Action.
The introduction of an Irish Sugar-Sweetened Drinks Tax (SSDT) was announced in Budget 2018 and came into effect on the 1st of May in 2018. The aim of the Irish SSD tax is to reduce rates of childhood and adult obesity in Ireland by reducing the consumption of sugar sweetened drinks as a contributor to health and dental deterioration, particularly among young people.
The desired outcomes are twofold: (1) that individuals reduce consumption of sugar sweetened drinks by reducing amount consumed or switching to healthier choices; (2) that industry reformulates products to reduce (not necessarily remove) levels of added sugar in the drinks products. An evaluation of the SSD Tax is in progress and is expected to be completed this year and will reveal the impact of the tax on the consumption of SSDTs and on reformulation of SSDT products.
In summary, this Government is committed to continued development and implementation of policies, programmes and initiatives that will reduce the obesogenic nature of our environment.
390. Deputy Brian Stanley asked the Minister for Health the number of patients over 70 and over 80 years, respectively who are deemed by the St. James’s Hospital multidisciplinary meetings consensus decisions and the conference on gastro-intestinal as unfit due to age to proceed with clinical treatment in the early stages of cancer that is, stage 1 and stage 2 in the years 2018 to date. [26852/24]
View answerAs this is a service matter, I have asked the HSE to respond to the Deputy directly, as soon as possible.
391. Deputy Brian Stanley asked the Minister for Health in relation to the decisions of the multidisciplinary meetings at St. James’s Hospital, under gastro-intestinal conference the number of patients over 70 and 80 years, respectively who were advised that radiotherapy or chemotherapy is not suitable in each of the years from 2018 to date. [26853/24]
View answerAs this is a service matter, I have asked the HSE to respond to the Deputy directly, as soon as possible.
392. Deputy Brian Stanley asked the Minister for Health in respect of multidisciplinary meetings at St. James Hospital, if it is the normal procedure to inform patients by letter if their cancer cannot be treated and need palliative care; the protocols that are in place to prevent this reoccurring. [26856/24]
View answerAs this is a service matter, I have asked the HSE to respond to the Deputy directly, as soon as possible.
393. Deputy Thomas Gould asked the Minister for Health if there are plans to increase funding and capacity for public PrEP services, such as those at the GUIDE clinic at St. James’s Hospital. [26860/24]
View answer394. Deputy Thomas Gould asked the Minister for Health if there are plans to allow GPs to provide PrEP to their existing patients. [26861/24]
View answer395. Deputy Thomas Gould asked the Minister for Health if there are plans to utilise the existing network of sexual health clinics and HIV/AIDS volunteer groups (details supplied) to increase availability of PrEP. [26862/24]
View answer396. Deputy Thomas Gould asked the Minister for Health if there are plans to allow online pharmacies to prescribe and deliver PrEP to customers in Ireland. [26864/24]
View answerI propose to take Questions Nos. 393 to 396, inclusive, together.
Sexual health is a priority for this Government. The National Sexual Health Strategy, 2015-2020, (NSHS), was launched in October 2015 and is implemented by the HSE Sexual Health and Crisis Pregnancy Programme (SHCPP). The NSHS aims to support sexual health and wellbeing across the lifecourse.
Following stakeholder consultation and an independent review, the Strategy is currently being re-drafted by an expert Group; a refreshed version is scheduled to be published in Q3-4, 2024. An independent Review by Crowe Ireland, published in 2023 on the Healthy Ireland website, identified 56 Priority Actions, of which 49 were assessed as having been successfully progressed. The Review also provides recommendations with regard to the future direction of the next NSHS.
Current priority sexual health deliverables include:
• Providing sexually transmitted infection (STI) and HIV prevention, diagnosis and treatment services, through the national network of 23 STI clinics and expansion of the nationwide home HIV and STI testing scheme
• HIV prevention, including HIV Fast-Track Cities, the Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) programmes, research, campaigns and supports to counter stigma for people living with HIV.
• Expanding access to free contraception, through the free contraception scheme for women and National Condom Distribution Service (NCDS).
• Prioritising monitoring, evaluation and research regarding sexual health, including progressing a comprehensive population survey on sexual health.
• Monitoring emerging STIs and changes in pathogenicity and/or transmissibility of existing pathogens (close links maintained with the Health Protection Surveillance Centre (HPSC) that collates STI incidence and trends, and the Health Information and Quality Authority (HIQA)).
• Improving sexual health education, training and resources, including schools, higher and further education, through www.sexualwellbeing.ie, in partnership with relevant NGOs
A national HIV pre-exposure prophylaxis (PrEP) programme commenced in November 2019, following a HIQA HTA, which concluded that its introduction would be safe, effective, and cost saving.
Free PrEP medication is available to individuals who meet clinical eligibility criteria, attending HSE approved PrEP services. These include public PrEP services, delivered through the public network of STI clinics, and some general practice (GP) services and private providers. There are currently 13 approved public PrEP services, located in public STI clinics, and 17 private or general practitioner (GP) PrEP providers. Appointments at the 13 public PrEP services are free of charge, however, the private providers charge for consultations.
The number of people eligible to access PrEP has been expanding since inception, with the number of individuals re-imbursed for PrEP at least once expanding from 1763 in 2020 (the first full year of service delivery), to 3388 in 2022 and 3802 by the end of Q4, 2023.
Clinical criteria for PrEP eligibility have been widened in recent years, increasing the number of people eligible for the programme. While the PrEP service continued to grow in 2023, many PrEP services are reaching (or have reached) capacity and service users are reporting challenges accessing appointments. By Q4, 2024, 6,070 individuals were approved for free PrEP medication.
Additional work is required to understand the extent of the unmet need/demand for PrEP, which has been estimated as circa 30%. Additional funding of €600,000 has been allocated in 2024 to further support delivery of the PrEP scheme, bringing the total allocation to €5.9m.
In order to increase capacity, a number of additional measures have been deployed and are being developed, including administrative efficiencies, the use of telephone consultations and use of the free home STI testing scheme for routine tests. In order to increase the number of providers, a PrEP competency framework and eLearning platform has been developed; these can be accessed by GPs with an interest in providing PrEP. The home STI testing scheme has received additional funding of €720,000 in 2024, bringing total funding for this to €4.22m
It is of vital importance that people at risk of HIV and living with HIV (PLHIV) are promptly linked to care, for prevention of onward transmission and for clinical benefit. It is also vital that those at risk are encouraged to access regular testing and preventive programmes such as PrEP. These measures are key elements towards achieving UN and WHO aims of ending the HIV/AIDS epidemic in Europe by 2030 and supporting wider national and international commitments.
In addition to further funding for both PrEP and for home STI testing in 2024, we are progressing further development of HIV Fast-Track Cities in Dublin, Cork, Limerick and Galway. We are also supporting people living with HIV and countering the stigma they may experience. To mark Pride Week, I will be launching a Community Garden, supported by the Department, at HIV Ireland’s HQ in Dublin, as part of Pride Week.
Additional capacity for PrEP delivery, through the public system, its partnerships and through primary care, are being considered as part of the wider ongoing work to redraft the National Sexual Health Strategy; it is envisaged that the new Strategy will be published in late Q3, 2024. Measures included for consideration will include a Model of Care for sexual health, to examine capacity and delivery, nationwide, in the context of HIV and STI rates that are rising both nationally and internationally. Additional capacity planned for 2025 will be considered as part of the Estimates process leading to Budget 2025.
Expanding the role of pharmacists is being actively progressed by the Minister for Health; primary legislation to support this is passing through the Houses of Oireachtas currently. The Expert Taskforce on Pharmacy are finalising their recommendations to the Minister, which further will inform development of both primary and secondary legislative frameworks and regulation to support the expansion of pharmacy.
The capacity for community sexual health partners to support PrEP delivery in line with clinical governance and frameworks for delivery; the feasibility of expanding the proportion of public STI clinics delivering PrEP and the clinical advisability (or otherwise) of allowing online pharmacies to prescribe and/or deliver PrEP are matters requiring significant expert clinical consideration and are therefore service matters for which the input of our HSE colleagues is essential.
As these are service matters, I have also asked the Health Service Executive to respond to the deputy directly, as soon as possible.
397. Deputy Niamh Smyth asked the Minister for Health the number of inspectors currently working for the Mental Health Commission; how many inspectors will be needed for the proposed expansion of the Mental Health Commission’s role under the Mental Health (Amendment) Bill 2023; and the costs associated with same; and if he will make a statement on the matter. [26865/24]
View answerThere are currently 14 WTE and 1 vacancy at Assistant Inspector level in the Mental Health Commission (MHC), working to the Inspector of Mental Health Services.
The Mental Health (Amendment) Bill 2023, as written, does not appear to grant any new statutory powers to the Commission to inspect, register and regulate mental health services outside of inpatient settings ('approved centres') so it is not possible to estimate what impact, if any, the 2023 Amendment Bill might have on resources required by the Commission.
The Government is in the final stages of preparing a comprehensive Mental Health Bill. A key proposal of the Government's Bill is to provide a robust legal framework for the expansion of the Commission's regulatory powers to include all community mental health services, including community CAMHS.
While the Department expects many of the proposed changes in the forthcoming Government Mental Health Bill to be dealt with generally within existing resources, preliminary work on costing the additional resources required by the Mental Health Commission, as the regulator of mental health services, and the HSE, as the main provider of mental health services, has been carried out.
The MHC engaged Deloitte in 2021 to review the operating model for their Regulatory Team, which includes the Inspectorate and Standards and Quality Assurance divisions. This was reviewed in early 2024. The MHC propose to increase the numbers of Assistant Inspectors to 31, who will report to six Deputy Inspectors.
This would cost in the region of €1.6m, based on existing salary levels.
A more in-depth exercise to estimate projected costs will be carried out prior to enactment of the Bill. Officials in my Department will work with key stakeholders to ready the sector for the commencement of the new Mental Health Act and will include the allocation of additional resources through the annual Estimates process.
More broadly, mental health services are moving towards more community-based care for people accessing mental health services, and away from prolonged care in inpatient mental health settings where possible, in line with our national mental health policy, Sharing the Vision, and Sláintecare. Continued investment in mental health services at all levels, including community and inpatient services, will be needed to ensure the continued efficacy and improvement of services and to continue to uphold the rights of people accessing services.
The Mental Health Bill was granted priority drafting for publication in the current legislative session and intensive work is ongoing to finalise the drafting of the Bill to ready it for publication in the coming weeks. The Bill will replace the existing Mental Health Acts 2001 – 2022 and overhaul our approach to mental health legislation.
398. Deputy Niamh Smyth asked the Minister for Health whether there were any derogations from the HSE recruitment embargo provided to mental health services in the period November 2023 to April 2024; and if he will make a statement on the matter. [26866/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond Directly to the Deputy as soon as possible.
